We sought to establish the interplay of metabolic syndrome (MetS) and/or sexual dysfunction (SD) on hypogonadism. Sexual functioning was assessed using Golombok Rust Inventory of Sexual Satisfaction in 274 consecutive diabetic men visiting the diabetic clinic of the Tema General Hospital between November 2010 and March 2011. MetS was assessed employing the criteria of World Health Organization, International Diabetic Federation and the National Cholesterol Education Program Adult Treatment Panel III while testosterone levels were estimated. The mean ages and duration of diabetes from this study were 59.9± 11.3 and 6.8 ± 5.9 years, respectively. The prevalence of hypogonadism was 7.3%, with the - SD/+MetS subjects showing the highest prevalence of hypogonadism, irrespective of the criteria used. Additionally, subjects with MetS and its components had a significantly lower level of testosterone compared with those without MetS and its components. Using standard nine-point scale, it was observed that subjects who avoided sexual act had significantly (P = 0.0410) lower testosterone values (5.8 ± 2.3 ng ml-1) than subjects who did not avoid sexual act (6.4 ± 2.6 ng ml-1). MetS alone impacted more on hypogonadism than SD alone or both conditions altogether.